She Can! EmpowerHER Workshop

Registration Information

Session Information

Session Name

If no options are appearing, all sessions are at capacity

Session Start Date

Time

Duration

Location

Session ID

Child Information

Child's First Name

Child's Last Name

School Child Currently Attends

Grade

Birthdate (mm/dd/yy)

Does your Child have any medical conditions, allergies or medications we should know about?

YesNo

Please provide additional medical information (including if your child has a puffer or epi-pen)

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Phone Number

Email Address

Street Address

Town/City

Postal Code

Secondary Contact

Secondary Contact First Name:

Who should we call if we can't reach you?

Secondary Contact Last Name:

Secondary Contact Phone Number (Must be different than Phone Number above):

Relationship to child

I understand that the She Can! Girls Empowerment Programs are for girls (inclusive of cisgender and transgender girls and nonbinary youth).

If I am late picking up, a 5 $ fee for every 15 minutes may apply.

I grant MCRC permission to use photos of my participant on their social media accounts, website, and on promotional materials. (Optional)

I would like to be added to the She Can! Email Mailing list. (Optional)

She Can! Programs rely on the generous donations of community members to keep these programs FREE for all participants. Any donation makes a difference and we appreciate your support. A donation of $15 covers the cost of program materials for 1 participant for this workshop . Would you like to make a donation to support She Can! Girls Empowerment programs?

NoYesPlease Note: This She Can! program is 100% free to attend and a donation is not required to participate.

Donations

She Can! programs rely on grants, fundraising and donations to continue this important work. Making a donation today would enable us to continue to provide the much needed program supplies to girls in our community for our upcoming programs.

Click here to make a She Can! donation!

Demographic Information

She Can! is asking parents/guardians to provide the following demographic information on behalf of their participant and family. We are collecting this information in order to identify and remove barriers to entry for our program, ensure equitable service delivery and programs, and be proactive in meeting the needs of our community.

Every question is optional, and you can choose to leave the question blank or select ‘choose not to answer’.

Your answers will be anonymous and this information will be kept confidential.

Please contact the She Can! supervisor at jessica.lowe@mcrc.on.ca.

What racial group best describes your participant?

A racial group not listed above

What is your participant's current citizenship status?

What is your participant's gender?

A gender identity not listed above

Do you consider your participant to be a person with a disability?

What is your family's household income?

Contact Information